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IHS National Pharmacy & Therapeutics Committee National Core Formulary; Last Updated: 09/23/2021 **Note: Medications in GREY indicate removed items.** Generic Pharmacological Category Formulary Brief (if Notes / Similar NCF Medications Active? Medication Name (up-to-date) available) Miscellaneous Acetaminophen Analgesic, Miscellaneous Yes Albuterol nebulized Beta2 Agonist Yes solution Alendronate Bisphosphonate Derivative Osteoporosis (2016) Yes Allopurinol Antigout Agent; Xanthine Oxidase Gout (2016) Yes Inhibitor Alogliptin Antidiabetic Agent, Dipeptidyl DPP-IV Inhibitors Yes Peptidase 4 (DPP-4) Inhibitor (2019) Amitriptyline Antidepressant, Tricyclic Antidepressants in Nortriptyline Yes Pain Mgmt (2014) Amlodipine Antihypertensive; Calcium Calcium Channel Diltiazem Yes Channel Blocker, Dihydropyridine Blockers (2014) Anastrozole Antineoplastic Agent, Aromatase Yes Inhibitor Apixaban Anticoagulant; Direct Oral Direct Oral Warfarin Yes Anticoagulant (DOAC); Factor Xa Anticoagulants (2017) Inhibitor Aspirin Antiplatelet Agent; Nonsteroidal Yes Anti-Inflammatory Drug; Salicylate Atenolol Antihypertensive; Beta-Blocker, Beta Blockers (2014) Metoprolol; Propranolol Yes Beta1 Selective Atomoxetine Norepinephrine Reuptake Inhibitor, ADHD (2020) Dextroamphetamine / Amphetamine (immediate release); Yes Selective Dextroamphetamine / Amphetamine (long-acting); Methylphenidate (immediate release); Methylphenidate (long-acting) Atorvastatin Antilipemic Agent, HMG-CoA Dyslipidemia Guideline Pravastatin; Rosuvastatin; Simvastatin Yes Reductase Inhibitor Review (2014) Azithromycin Antibiotic, Macrolide STIs - PART 1 (2021) Yes Printed on 09/26/2021 Page 1 of 16 National Core Formulary; Last Updated: 09/23/2021 Generic Medication Name Pharmacological Category (up-to-date) Formulary Brief Notes / Similar NCF Medications Active? (if available) Miscellaneous Benzoyl Peroxide Topical Skin Product, Acne Acne Treatment Benzoyl Peroxide AND Clindamycin, topical Yes (2020) combination Benzoyl Peroxide AND Clindamycin, Topical Skin Product, Acne; Topical Skin Acne Treatment Benzoyl Peroxide Yes topical combination Product, Acne (Lincosamide Antibiotic) (2020) Bictegravir/emtricitabine/tenofovir Antiretroviral, Integrase Inhibitor (Anti-HIV) HIV Treatment Dolutegravir/abacavir/lamivudine; Yes alafenamide (2019) Emtricitabine/tenofovir disoproxil fumarate; Raltegravir Bupropion Antidepressant, Nicotine Varenicline; Venlafaxine Yes Dopamine/Norepinephrine-Reuptake Inhibitor; Dependence Smoking Cessation Aid (2015) Carbamazepine Anticonvulsant, Miscellaneous Antiepileptics Divalproex; Lamotrigine; Levetiracetam; Yes (2014) Phenytoin; Topiramate Carbidopa-Levodopa (immediate Anti-Parkinson Agent; Decarboxylase Parkinson's Yes release) Inhibitor-Dopamine Precursor Disease (2019) Ceftriaxone Injection Antibiotic, Cephalosporin STIs - PART 1 Cefixime Yes (2021) Chlorthalidone Antihypertensive; Thiazide-Related Diuretic Diuretic Agents Hydrochlorothiazide Yes (2014) Citalopram Antidepressant, Selective Serotonin Reuptake SSRIs (2019) Escitalopram; Fluoxetine; Paroxetine; Yes Inhibitor Sertraline Clonazepam Benzodiazepine Alcohol Lorazepam Yes Withdrawal Syndrome (2015) Clopidogrel Antiplatelet Agent Antiplatelets Aspirin Yes (2015) Corticosteriods (Topical) - High Topical Corticosteroids Psoriasis (2018) Corticosteroid (Topical) - Intermediate Yes potency (Class I and II) potency; Corticosteroid (Topical) - Low potency Cyanocobalamin (Vitamin B12), oral Vitamin, Water Soluble Hematologic Yes Supplements (2016) Dicyclomine Anticholinergic Agent Irritable Bowel Yes Syndrome (2018) Printed on 09/26/2021 Page 2 of 16 National Core Formulary; Last Updated: 09/23/2021 Generic Medication Name Pharmacological Category (up-to-date) Formulary Brief (if Notes / Similar NCF Medications Active? available) Miscellaneous Digoxin Antiarrhythmic Agent, Miscellaneous; Digoxin Use (2016) Yes Cardiac Glycoside Diltiazem Antihypertensive; Calcium Channel Calcium Channel Amlodipine Yes Blocker, Nondihydropyridine Blockers (2014) Divalproex Anticonvulsant, Miscellaneous ER Lithium & Divalproex Carbamazepine; Lamotrigine; Levetiracetam; Yes (2012) Phenytoin; Topiramate Doxazosin Alpha1 Blocker; Antihypertensive Benign Prostatic Prazosin; Tamsulosin Yes Hypertrophy (2016) Doxycycline Antibiotic, Tetracycline STIs - PART 1 (2021) Yes Duloxetine Antidepressant, Serotonin/Norepinephrine Diabetic Neuropathy Bupropion; Venlafaxine Yes Reuptake Inhibitor/Antagonist (2018) Empagliflozin Antidiabetic Agent, Sodium-Glucose SGLT-2 Inhibitors (2019) Yes Cotransporter 2 (SGLT2) Inhibitor Escitalopram Antidepressant, Selective Serotonin SSRIs (2019) Citalopram; Fluoxetine; Paroxetine; Sertraline Yes Reuptake Inhibitor Estradiol tablets Estrogen Derivative Menopausal Hormone Yes Therapy (2016) Ethambutol Antitubercular Agent Isoniazid; Pyrazinamide; Rifampin; Rifapentine Yes Ethinyl estradiol / Contraceptive; Estrogen and Progestin Contraception (2016) Yes Etonogestrel vaginal ring Combination Ethinyl estradiol / Contraceptive; Estrogen and Progestin Contraception (2016) Yes Norelgestromin, Combination transdermal Ethosuximide Anticonvulsant, Succinimide Anti-Seizure Drugs (2021) Carbamazepine; Clonazepam; Divalproex; Yes Gabapentin; Lamotrigine; Levetiracetam; Phenytoin; Topiramate Ezetimibe Antilipemic Agent, 2-Azetidinone 2018 ACC/AHA Yes Cholesterol Guidelines (2019) Printed on 09/26/2021 Page 3 of 16 National Core Formulary; Last Updated: 09/23/2021 Generic Medication Name Pharmacological Category Formulary Brief (if Notes / Similar NCF Medications Active? (up-to-date) available) Miscellaneous Finasteride 5 Alpha-Reductase Inhibitor Benign Prostatic Yes Hypertrophy (2016) Fluoxetine Antidepressant, Selective Serotonin Sertraline Yes Reuptake Inhibitor Fluticasone/salmeterol Beta2 Agonist, Long-Acting; LABAs (2019) Mometasone (Asmanex®) Yes Corticosteroid, Inhalant Furosemide Antihypertensive; Loop Diuretic Heart Failure Overview Yes (2017) Gabapentin Anticonvulsant, Miscellaneous; GABA Gabapentin & Pregabalin in Yes Analog Pain (2014) Glecaprevir/pibrentasvir Antihepaciviral HCV Treatment (2018) Ledipasvir/sofosbuvir (Harvoni®); Yes (Mavyret®) Sofosbuvir/velpatasvir (Epclusa®) Glipizide Antidiabetic Agent; Sulfonylurea Sulfonylureas (2015) Yes Hydrochlorothiazide Antihypertensive; Thiazide Diuretic Diuretics (2014) Chlorthalidone Yes Hydroxychloroquine Antimalarial Non-biologic DMARDs Leflunomide; Methotrexate; Sulfasalazine Yes (2016) Hydroxyzine Histamine H1 Antagonist, First Anxiety Disorders (2021) Yes Generation Ibuprofen Nonsteroidal Anti-Inflammatory Drug NSAIDs (2014) Diclofenac; Indomethacin; Meloxicam; Naproxen Yes Indomethacin Nonsteroidal Anti-Inflammatory Drug NSAIDs (2014) Diclofenac; Ibuprofen; Meloxicam; Naproxen Yes Isoniazid Antitubercular Agent Ethambutol; Pyrazinamide; Rifampin; Rifapentine Yes Isosorbide mononitrate Antianginal Agent; Vasodilator Nitroglycerin 0.4 Milligrams; Sublingual; Yes Nitroglycerin patch Printed on 09/26/2021 Page 4 of 16 National Core Formulary; Last Updated: 09/23/2021 Generic Medication Name Pharmacological Category Formulary Brief (if Notes / Similar NCF Medications Active? (up-to-date) available) Miscellaneous Lactulose Ammonium Detoxicant; Laxative, Cirrhosis & Polyethylene glycol Yes Osmotic Complications (2015) Lamotrigine Anticonvulsant, Miscellaneous Antiepileptics (2014) Carbamazepine; Divalproex; Levetiracetam; Yes Phenytoin; Topiramate Ledipasvir/sofosbuvir Antihepaciviral HCV Treatment (2018) Glecaprevir/pibrentasvir (Mavyret®); Yes (Harvoni®) Sofosbuvir/velpatasvir (Epclusa®) Leflunomide Antirheumatic, Disease Modifying Non-biologic DMARDs Hydroxychloroquine; Methotrexate; Sulfasalazine Yes (2016) Letrozole Antineoplastic Agent, Aromatase Yes Inhibitor Levetiracetam Anticonvulsant, Miscellaneous Antiepileptics (2014) Carbamazepine; Divalproex; Lamotrigine; Yes Phenytoin; Topiramate Levothyroxine Thyroid Agent Yes Lisinopril Antihypertensive, ACEIs & ARBs in Heart Yes Angiotensin-Converting Enzyme Inhibitor Failure (2017) Lithium Antimanic Agent ER Lithium & Divalproex Yes (2012) Loperamide Antidiarrheal Irritable Bowel Syndrome Yes (2018) Lorazepam Benzodiazepine Alcohol Withdrawal Clonazepam Yes Syndrome (2015) Losartan Antihypertensive, Angiotensin II ACEIs & ARBs in Heart Yes Receptor Blocker Failure (2017) Medroxyprogesterone Contraceptive, Progestin Contraception (2016) Medroxyprogesterone, oral; Oral contraceptive pill, Yes acetate, injection (Injection/Depot) progestin only Medroxyprogesterone, oral Contraceptive; Progestin Polycystic Ovarian Medroxyprogesterone acetate, injection; Oral Yes Syndrome (2017) contraceptive pill, progestin only Printed on 09/26/2021 Page 5 of 16 National Core Formulary; Last Updated: 09/23/2021 Generic Medication Pharmacological Category Formulary Brief (if Notes / Similar NCF Medications Active? Name (up-to-date) available) Miscellaneous Meloxicam Nonsteroidal Anti-Inflammatory Drug NSAIDs (2014) Diclofenac; Ibuprofen; Indomethacin; Naproxen Yes Memantine N-Methyl-D-Aspartate (NMDA) Yes Receptor Antagonist Metformin Antidiabetic Agent; Biguanide Yes Methimazole Antithyroid Agent; Thioamide Hyperthyroidism Propylthiouracil Yes (2021) Methotrexate Antineoplastic Agent; Antirheumatic; Non-biologic Hydroxychloroquine; Leflunomide; Sulfasalazine Yes Disease Modifying; Immunosuppresant DMARDs (2016) Agent Metoprolol Antihypertensive; Beta-Blocker, Beta1 Beta-blockers in Heart Atenolol; Propranolol Yes Selective Failure (2017) Moisturizers (both cream- Skin and Mucous Membrane Agent, Atopic Dermatitis
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